Permit -
CITY TIGARD PLUMBING PERMIT
'% DEVELOPMENT SERVICES PERMIT #: PLM2006 -00123
° ' I I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/7/2006
PARCEL: 2S 109DA -06200
SITE ADDRESS: 15058 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 039 JURISDICTION: TIG
Project Description: Residential backflow prevention device for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
DON MORISSETTE COMMUNITIES LLC Description Date Amount
4230 GALEWOOD ST. STE 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/7/2006 $36.25
[TAX] 8% State Surchan 4/7/2006 $2.90
Phone : 503 387 - 7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Contact # : PRI 503- 692 -5945
FAX 503- 692 -0768
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 5 -246- 99 r 1- 800 - 332 -2344.
Issued y: Permittee Signat 401111111P L'o't &- tp --
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
ir‘
Building Fixtures
. .
Plumbing Permit Applicatkp FOR OFFICE USE ONLY
Received j , II
Permit No.:
13 l25 SW Hall Blvd., Tigard, OR 972V --"%, 1‘
'
,A. Date/By: 7
Plan Review .
•
Phone: 503.639.4171 Fax: 503.598.1 .0 c i-_ i k , 4441,00N Date/By: Other Per, 't No.:
24- Hour Inspection Line: 503.639.4175
I'S`i'S ,r...i :ter".. ' ( .' 1 4 , ..„:, .. Date Ready/By: 1 .' ' El See Page 2. tar
Internet: www.ci.tigarclor.us r'. '• c ,' Notified/Method: ' VT Supplemental Information
. ..:',.. : f...;, * 5*0 -.6 *..Ni;i Wict..;',. '-e7''P:' : ,....::::,.:.„.::.., Fo*...sct.004" -',- • i . •
New construction For special information use checklist. 1
, Description I Qty. I Ea. I Total
ddition/alteration/replacement - 9,3 Ai'Other: New 1 - 2-family dwellings (includes 100 ft. for each utility connection)
.. • • . • . ...,... ..• - - •• . - . -•, .. •. , .•• • -• . ... .. - " .. _
• • • '..*•:. '... ' ' ... • '''' .• CATEGORY. OF - . , - - - • •••'. • • " --..• • SFR (1) bath 1 249.20
I- and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
El Accessory building 0 Multi
Each additional bath/kitchen 45.00
D Master builder 11:1 Other:
Fire sprinkler ( sq. ft.) Page 2
•;2:.: ', ..7 :- .: :-. , ... • • .:::: . Site utilities
Job site address: ' 5 C. - S :i--(j (ft (.',, - 17 tc-...c._ D&. Catch basin or area drain I 16.60
City/State/GU': 7 / ci---Z e. a /Q C i 7 ;-D-11 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear fl.: ) Page 2
Suite/bIdglapt. no.: r;roject name:
Manufactured home utilities . I 10.00
Cross strect/directions to job site:
Manholes 16.60
5 L.c..., 8 c - e 7. /Z 4 /La__ --/:, Rain drain connector 16.60
Sanitary sewer (no. linear ft.. ____) Page 2
Storm sewer (no. linear ft.: ) Page 2
- T •
_ Water service (no. linear El: ) Page 2
Subdivision: ,S4....ii fr \ L.f tall-9 _... Lot no:4Y)
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
- ' '''' --- ' - • ' ' ' • - ' ' '• '.' .•
'-.' . : Backflow preventer Page 2 0_ 7
i
; 1" ,r i 0 </7 ."-", ..,:" if /7 L. LI ,j,.....i ; < tt ... Bacicwater valve 16.60
Clothes washer 16 60
Dishwasher 16.60
. l 6.60
: ..I '' lP • ii.4,g*O - : -- OWNtR- .,... ' ..- .. fli.:4;' ',•.. . , ',iiii,::ip6i:r , '4 . .: .1 '...: .. - Drinking fountain
,.:,
.
16 60
Name: D ( /"')<' s .... , .f.. ,, -41:::azr.: turn trio_ ruch e.s L.L.C.Expansion tank 16.60 I
Address: L ...., ,j f __ Li-.-. -.. / (...' C.'. t...) 0 ( Fixture/sewer cap 16.60
City/State/ZIP:Li A:: (2_ C.: \ i_ I_ ! C y C (....)k. 4 / . 7 C-.?., 1.:-_, Floor drain/floor sinlc/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 , Hose bib 16.60
..) ....,,.,:; . .::: I 1 - :,:. : ; ..s..' ...„, TAcT,,rIP2SOINF
Ice maker 16.60
Business name: ii a ..; e oi , ,:-..: L',,, 0 ,f/ T.,..--,. <_-_, Interceptor/grease trap
I 16.60
Contact name: .- : ...2,..) ,...S .: ;. ,,! Medical gas (value: S ) Page 2
Address: i I ,9 D 00 to frki.,c I ivri j: OD Primer 16.60
City/State/ZIP: it, ii A C.)1,'"L ' • -
::: 7( „i -, \
i kZ.- '''.--- Roof drain (commercial) l 6.60 . !
. ;- Sink/basin/lavatory 16.60
Phone: (50 3) f.,..: q .-) - ...._S=7 F.) Fax: : ( L',....:- -., !;,..'" .4 - L - ,A.:- A " •
Tub/shower/shower pan 16 60
E-mail: Urinal I 6 60
tON1RACTOR Water closet . . .. . . .. .. . . .. , .
. . . .. . . . . . • .. . • .. . . . .. . . .
. 16.60 . ..
Business name: Lt f tl_S e , ,,.., ,:-, . Ore' ;Z:c) c Water heater _ _. , 16 60
___
i --
I Other:
• ---
(......, c ' _ •
, i.... ,.....
1 -"'" _ ___;•: ■,) :.(..) f 'I , -1 • . i • '- - -- - .T.7):1 - 1 -
- .
City/Statc/LTP: 2 /4l-\ ‘"0,C.. - ./ " D._ _--.
1■.1 inmum permit fee: 572.50
P1-tone: (5 &Q 5 ‘94-il-s" Fax: 60.3) 69C - 07 (e> E' Residential backflow , permit fee: 536.25 31c. j•--S
CCBLic.: 7 it) Plumbing Lic. no.:
signa . ".6 (Zit (a4_4......err-t7
,/
Plan review (25% of permit fee)
Authorized sig
State surcharge (8% of permit fee) c ;)._ ,
TOTAL PERMIT FEE I 3/ ,! S
Print name e ,._.. 0.../^. Datil- ( e --- °t 1 This permit application expires if a permit is not obtained %, :thin
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Boa: d
iMiuildinggermits \PIMF-PerrodApp doe 12/03 440
a - d 89Z-0-ass-EDS u a I 1 3 dII:20 90 90 add
CITY OF TIGARD
BUILDING DIVISION PERMIT #:P/pi.i ]-6v( 0 orp-3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 -, pm�i;��l+1\
AA
Inspection Requests (24 Hrs.): (503) 639 -4175 I.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: /vSV dye eN of T CLASS OF WORK:
SUBDIVISION: I . LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: LS2 (01 2 4S'
CONTRACTOR: G ��o� PHONE #:
Inspection Request Scheduled For: Date: q r / O — 0 G Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions: •
•
Or-PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Ll ; �j
Inspector: Date: / � " Phone #: (503) 718-
•
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